Volume 5, Issue 2, March 2017, Page: 19-25
Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence
Waleed Abdelfattah Mousa, Department of Diagnostic Radiology, Menoufia University, Menoufia, Egypt
Tarek Fawzy Abdella, Department of Diagnostic Radiology, Menoufia University, Menoufia, Egypt
Received: Dec. 19, 2016;       Accepted: Jan. 3, 2017;       Published: Mar. 25, 2017
DOI: 10.11648/j.ijmi.20170502.13      View  1650      Downloads  71
Objective: MRI is currently the imaging modality of choice for the detection, characterization, and staging of rectal cancer. A variety of examinations have been used for preoperative staging of rectal cancer, including digital rectal examination, endorectal (endoscopic) ultrasound, CT, and MRI. Endoscopic ultrasound is the imaging modality of choice for small and small superficial tumors. MRI is superior to CT for assessing invasion to adjacent organs and structures, especially low tumors that carry a high risk of recurrence. Background: Colorectal cancer (CRC) is the third most common cancer in both sexes combined worldwide, after prostate and breast cancer with an incidence of 40 in 100,000. Rectal carcinoma accounts for more than one-third of colorectal tumors and is associated with significant morbidity and mortality. Currently, MRI using diffusion weighted sequence is the most sensitive and specific modality in staging rectal cancer as it is able to depict the mesorectal fascia and its relation to the tumor margins precisely. Methods: This study included 50 patients, (32 male and 18 female) previously diagnosed as cancer rectum based on proctoscope and histopathological biopsy. The age range of the patients was from 18 years to 78 years. All patients will be subjected to the following: detailed history, clinical examination, proctoscopic assessment and histopathological data. All patients underwent MRI of the pelvis specifically cancer rectum protocol. Results: The most frequently encountered clinical presentation among cancer rectum patients was bleeding per rectum (14), constipation (26), incidentally discovered liver metastasis (6) and intestinal obstruction (4). MRI evaluation of T staging in correlation to the histopathological examination showed sensitivity (80%), specificity (93%), accuracy (94%). Lymph node (LN) metastatic spread was evaluated by MRI and showed sensitivity (87%), specificity (92%), accuracy (92.6%), PPV (84.8%) and NPV (96.7%). Regarding circumferential resection margin (CRM) MRI assessment revealed; sensitivity (96%), specificity (94%), accuracy (96%), PPV (95%) and NPV (94.3%). Conclusions: MRI is an accurate and sensitive imaging method delineating tumoral margins, mesorectal fascia involvement, lymph nodes, and distant metastasis. MRI can accurately delineate the mesorectal fascia involvement, which is one of the main decision points in planning treatment.
Magnetic Resonance Imaging, Diffusion, Cancer Rectum, Tumor Staging
To cite this article
Waleed Abdelfattah Mousa, Tarek Fawzy Abdella, Rectal Carcinoma, Recent Staging Strategy by MRI Using Diffusion Weighted Sequence, International Journal of Medical Imaging. Vol. 5, No. 2, 2017, pp. 19-25. doi: 10.11648/j.ijmi.20170502.13
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Siegel R, Naishadham D, Jemal A. Cancer statistics, CA Cancer J Clin 2013; 63: 11–30.
Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. 1997: 12: 594–642.
D. M. Ganeshan, et al. MRI Evaluation of Rectal Carcinoma, Cross-Sectional Imaging of the Abdomen and Pelvis: A Practical Algorithmic Approach, New York: Springer, 2015: 417-433.
Klessen, C., Rogalla, P., & Taupitz, M. Local staging of rectal cancer: the current role of MRI. European radiology 2007; 2: 379-389.
Ümit Tapan, Mustafa Özbayrak, Servet Tatlı. MRI in local staging of rectal cancer: an update. Diagnostic Interventional Radiology 2014; 20: 390-398.
Suk Hee Heo, Jin Woong Kim, Sang Soo Shin, et al. Multimodal imaging evaluation in staging of rectal cancer. world journal of gastroenterology 2014; 15: 4244-4255.
Harmeet K, Haesun C, Y Nancy Y, et al. MR Imaging for Preoperative Evaluation of Primary Rectal Cancer: Practical Considerations radioGraphics 2012; 3: 389-409.
J. Evans, U. Patel, and G. Brown. Rectal Cancer: Primary Staging and Assessment After Chemoradiotherapy Seminars on Radiation Oncology 2013; 21: 169-177.
Brown G, Richards CJ, Newcombe RG, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999; 211: 215–222. [PubMed]
Shihab OC, Heald RJ, Rullier E, et al. Defining the surgical planes on MRI improves surgery for cancer of the low rectum. Lancet Oneal. 2009; 10: 1207–1211. [PubMed]
H. Kwok, I. P. Bissett, G. L. Hill. Preoperative staging of rectal cancer. International Journal of Colorectal Disease. 2000; 15: 9-20
Elizabeth Furey, Kartik S, Jhaveri. Magnetic resonance imaging in rectal cancer. Clinics Northern America 2014; 22: 165-190.
Rao S-X, Zeng M-S, et al. Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention. World J Gastroenterol. 2007; 13: 4141-4146.
Algebally AM et al. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging. Pol J Radiol. 2015; 80: 115-21
Matsuoka H, Nakamura A, Masaki T, et al. Optimal diagnostic criteria for lateral pelvic lymph node metastasis in rectal carcinoma. Anticancer Res. 2007; 27: 3529-3533
Wong, et al. Effect of endorectal coils on staging of rectal cancers by magnetic resonance imaging. Hong Kong Med J 2010; 16: 421-439.
C. C. Moreno, et al. Magnetic resonance imaging of rectal cancer: staging and restaging evaluation. World J Gastroenterol 2014; 15: 4244-4255.
Zhang XM, Zhang HL, et al. 3-T MRI of rectal carcinoma: preoperative diagnosis, staging and planning of sphincter-sparing surgery. AJR Am J Roentgenol 2008; 5: 1271–8.
HY. Lee et al. Prognostic Significance of Metastatic Lymph Node Ratio in Node-Positive Colon Carcinoma. Annals of Surgical Oncology 14; 5: 1712-1717.
Brown G, Richards CJ, Bourne MW, et al: Morpho¬logic predictors of lymph node status in rectal can¬cer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003; 2: 371-377.
Eisar Al-Sukhni, Laurent Milot, Mark Fruitman, et al. Diagnostic Accuracy of MRI for Assessment of T Category, Lymph Node Metastases, and Circumferential Resection Margin Involvement in Patients with Rectal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2012; 19: 2212-2223.
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